Utility Placement Permit Instructions
A Utility Placement Permit covers utility work done in the right-of-way.
APPLICATION REQUIREMENTS:


Application Fee. There is no fee for this permit.
Utility Placement Permit Application & Plan.
· Fill out and submit the completed Utility Placement Permit Application to the Department
of Transportation and Development, Transportation Engineering Division. If you have
questions, please call the Permit Specialist at 503-742-4691.
· Submit the following with the completed application:
 Two sets of Project Plans
 Two sets of Traffic Control Plans
 One copy of the Certificate of Liability insurance naming Clackamas County as the additional insured,
with the Additional Insured rider attached.

Permit Issuance.
· After the Permit Specialist reviews the plan for completeness it is forwarded to the
inspector for review. The applicant is notified if anything further is required. Once the
permit is approved the permit is issued and emailed to the applicant.
· The contractor is required to have a copy of the permit and approved plans on the job site
during construction.
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Inspections.
· Call the Inspection Request Line at 503-742-4700 to notify the inspector of the start date
of work and after the work is completed to schedule the inspection to start the warranty
period.
Timeline.
· The utility work shall be completed to the satisfaction of Clackamas County by the
expiration date on the permit. Contact your inspector if you are unable to meet this
timeline.
Additional Information.
Oregon law requires the applicant to follow rules adopted by the Oregon Utility
Notification Center set forth in OAR 952-001-0010 through OAR 952-001-0090. You may
obtain copies of the rules by calling the Center at (503) 232-1987.
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Notes:
Clackamas County Transportation Engineering Division 150 Beavercreek Road, Oregon City, OR 97045
Phone (503) 742-4400 Fax (503) 742-4659 www.clackamas.us
Rev. Date 02-03-2015
Form #: EN-0001-0
Utility Placement Permit Application
Office Use Only:
for Utility Work in the Right of Way
UP#:
TYPE OF WORK
Description of work:
Plow Bore Core Drill Pole Street Cut Trench (shoulder work) Hole Hog Other (specify):_________________
Utility type:
Cable Electric Gas
Phone Sanitary
Storm
Telecomm
Water Other (specify):_________________
Size of proposed excavation: Note: Depth - 30" minimum below lowest point of the existing road and ditch grade
Width________________in. / ft.
Depth________________in. / ft.
Length________________in. / ft.
Width________________in. / ft.
Depth________________in. / ft.
Length________________in. / ft.
Width________________in. / ft.
Depth________________in. / ft.
Length________________in. / ft.
Proposed start date:
Proposed completion date:
JOB SITE INFORMATION AND LOCATION
Site address:
City/State/ZIP:
Nearest cross street and/or nearest address:
Business or subdivision name:
APPLICANT INFORMATION
CONTRACTOR INFORMATION
REQUIRED 24-Hour Emergency Phone Number:
Applicant's project number:
CCB lic.:
Contact name:
Business name:
Business name:
Contact name:
Phone:
Phone:
Cell:
Mailing address:
Mailing address:
City/State/ZIP:
City/State/ZIP:
Email address:
Email address:
Cell:
ATTACHMENTS
Attach two sets of project plans.
Plans prepared by:
Attach two sets of traffic control plans.
Plans prepared by:
I certify that I have read and examined this permit application. I agree to build according to the provided description, accompanying
plans and specifications, and any other State and local laws regulating the construction within the road right-of-way.
Applicant's signature:
Print name:
Date:
COUNTY ENGINEERING STAFF ONLY
Map Page/Section:________________________________
 AERIAL/POLES
 CORE DRILLS
Road Number:
 PLOW
Land Use File Number: Z0
Development Permit Number: SC
Inspector:
 Duffy Gehrts
BORE/PUSH
 GRANULAR
 CDF
 GRANULAR NO ST. CUT
 Bruce Brown  Dawn Hickson
Notes:
Clackamas County Transportation Engineering Division 150 Beavercreek Road, Oregon City, OR 97045
Phone (503) 742-4400 Fax (503) 742-4659 www.clackamas.us
Rev. Date 12-17-2015
Form #: EN-0001-0